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NPI Code Detail

MEDICARE: STONEBRIDGE SCC, LLC

MEDICARE: STONEBRIDGE SCC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902131162
Entity Type Code : Organization
Provider Name (Legal Business Name) : STONEBRIDGE SCC, LLC
Provider Business Mailing Address
First Line : 600 N PEARL ST STE 1050
Second Line :
City : DALLAS
State : TX
Zip : 75201-7495
Country : US
Telephone Number : 214-252-7600
Fax Number : 214-252-7704
Provider Business Practice Location Address
First Line : 11127 CIRCLE DR
Second Line :
City : AUSTIN
State : TX
Zip : 78736-7767
Country : US
Telephone Number : 512-443-3436
Fax Number : 512-445-4211
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. MICHAEL BEAL
Credential :
Telephone Number : 214-252-7600
Provider Enumeration Date : 10/06/2009
Last Update Date : 03/02/2020

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